Life (and death)...

Tuesday, January 28, 2014

3 More Days!

3 more days to Chinese New Year.

While the excitement is palpable in Malaysia and perhaps even in social media, admittedly it's not much celebrated here.

However, I take pleasure in wishing my Asian patients "Happy New Year"; apparently the cultures overlap much amongst groups- my Vietnamese and Filipino patients tell me they celebrate the same festival, too.

And so this weekend, we're getting together some people for our own CNY do.

And, funnily enough, something I've taken for granted growing up- I actually PAID money to download Chinese New Year songs from Amazon.

Yea, me. Dr. Banana- someone who can't speak a word of Mandarin, who can't understand the words of the songs. However, someone who still finds great comfort hearing those mildly irritating, upbeat songs sung by kids.

We also have our CNY wall hangings ready to be put up. And a stack of (very old) ang pows to fill.

By this time back home, we'd be getting our new year clothes out, and ready to be worn for Day 1. And my brothers and I would be excitedly dividing up our stash of fireworks, to be used on the first night.

Sunday, January 26, 2014

Bacon Cupcakes!

I just had to share this.

In my mind, there was no logical existence for it, unless perhaps a devious creation by the makers of insulin.

A cupcake laced with, and topped with.... bacon!

It seemed like such a weird, illogical and contradictory combination that I just had to try it. The salty, crispy bacon against the fluffy mild sweetness of the cupcake, and the creamy, sweet cream cheese frosting. And surprisingly, while my tastebuds got a bit confused (not unlike when I tried chocolate covered potato chips), it was pretty damn good!

But alas, it doesn't take a genius to figure out its nutritional value, or lack of it. Which explains why my job exists.﻿

Wednesday, January 22, 2014

Back to Memory Lane

This is something I've been meaning to post for months since we got back, but as usual, kids take up all your time. Something I was keen to do the last trip back to Malaysia was to show my kids places their dad went to. And so, one morning, we drove to my old kindergarten with Allison (Ava was too young, so we left her with grandparents). The headmistress was kind enough to let us visit, though having a kwaipoh roam the yard was somewhat disruptive to the kids having classes methinks!

Being in preschool now, Alli had some inkling to what kindergarten was. However, with how different the systems are between the USA and Malaysia, I think she found it hard to fathom (my wife too, I think). The huge class sizes. The relatively spartan conditions. The dirty toilets, with the squatting potty, no less.

For me, it was certainly a trip back to memory lane. It is the same building, at the same location I went to 30 years ago (WTF??? Really, 30 years???). And though the memories are mostly long gone, I do remember much.

Like where my classroom was (yellow class, with Ms. Janet as our teacher). I remember where the toilet was, and how even then, I hated to take a dump outside of home (I remember the day when I did have to take a dump and my kindergarten sweetheart Salina happened to walk in on me!). I remember Sports Day; I think I won a price in the tube race. I remember the biscuits they used to serve at break time- I loved those chocolate wafers (to my delight I can find them here) and those pea-sized biscuits with the sugar frosting on top. I remember the ?ivy plant in the back, and how we used to pluck the leaves and stick it to our forearms. I remember the concert night (or whatever they called it, but I remember it as the concert). When we all dressed up and performed on stage; I remember dad buying me and Hon Hui a bottle of Yeos strawberry drink. And I remember the damn lipstick they put on me for the performance!

Anyone find me?

But perhaps my fondest memory, now that I'm a dad, is my Ah Kong. I used to be the most homesick kid in the world. I had screaming, howling, crying escapades whenever my parents dropped me off (actually carried on until Standard 1!). Anyway, after some unsuccessful drop-offs, they got desperate, and finally talked my grand-dad into coming to kindergarten with me.

As in, staying there the entire class! I remember how Ah Kong would sit on the bed outside my classroom while I was in class. That must have been for at least 4-6 hours each time? I remember how nervous I got whenever he stepped out of view.

I don't remember how long he had to do this, but it was certainly long enough that I remember this fondly.

(sidenote: Don't you think it's ironic that having been such a homesick boy, I ended up settling down farthest from Malaysia amongst my siblings?)

Yes, Alli and Ava will have their own experiences here in the USA, experiences that will be foreign to me still. But I'm glad I was able to take her there for a visit.

Sunday, January 19, 2014

Sundog

Just when you thought it was safe to come out (after all, the snow had pretty much melted, and it was 8C!), winter comes and plays a cruel joke. We get a huge dump of snow, with whiteout conditions. Stories of 30-car pile-ups on the interstate. It took us 80 minutes to drive 12 miles home.

But, if there is one thing to enjoy out of this, this was the view from my office the next morning:

Sun dogs.

No, not an actual dog. But that bright, rainbow colored ring around the sun. Diffraction of the sunlight into its spectral components by the ice crystals in the air. Or something like that.

Friday, January 17, 2014

Bureaucratic Nonsense

Had to fight off hematemesis today when I received a letter from a patient's insurance.

Mr. X has type 2 diabetes, and at his last visit with me two months ago, had complained of erectile dysfunction. His usual screening labs were negative and so we discussed the option of phosphodiesterase inhibitor therapy. He was keen on trying sildenafil, so I sent in a prescription.

He also had a history of coronary artery disease, for which he received 2 stents 9 years ago. He was prescribed sublingual nitroglycerin to be used only as needed if he had more chest pains. Which he never did since his intervention. But, like the obedient patient that he is, he kept refilling the nitro prescription his cardiologist gave him, "just in case". We discussed the side effects and the potential major interaction between these two agents, but felt that since he has never taken the nitro in the 9 years he has had a prescription, it would be OK taking sildenafil as needed.

And so, this started a bureaucratic roller coaster which is still in mediation. His insurance company said "No", because an astute clerk had noted nitro in his medlist. The fax had a number the physician or patient could call to appeal the denial, and to review the case with a medical reviewer.

Now, I can understand the concern seeing Viagra and nitro on the same list, so I called the 1-800 number to review with a pharmacist reviewer. And I clearly explained that although nitro is listed on his medlist, it is a PRN (as-needed) medication, one he has NEVER used in the 9 years he has had this. And I explained that the patient is aware never to take both medications at the same time. The pharmacist seemed understanding, and agreed it was OK and promised to relay this to the people who approve these things.

A week later, I receive another fax. No. Because your patient was noted to be on nitroglycerin.

Which prompted me to write a letter this time, again explaining that the nitro was a formality- though he was prescribed this, he had NEVER used it. While on the other hand his erectile dysfunction was significant enough to be causing quality-of-life issues. Explained that the patient is aware of the interactions. I signed and sent this letter off to Insurance Company From Hell.

And then today, I receive another letter. "Your appeal letter cannot be processed because you are not an authorized representative of the patient".

What the frak??? I am the prescriber, and by that alone, I am a representative of the patient. And if I wasn't authorized to be speaking for the patient, WTF did you send me those two faxes anyway??

Anyway, I was required to get the patient to sign a 4 page form, stating that I am indeed an authorized health representative for him.

Never mind that I've been his endocrinologist for the last 3 years.

And people wonder why they say that medicine would be a lot cheaper and simpler without insurance companies and lawyers.

Sunday, January 12, 2014

Yum

So, the festivities are over.

Thanksgiving.

Christmas.

New Year.

No more holidays. But yet, it's bloody cold. And the next big festival, Chinese New Year, which for my family was THE festival of the year, is virtually nonexistent in Midwest USA. And so, this is probably the time of year when homesickness is worst. And so, in an attempt to bring some of 'home' to my home, I've been looking at instant noodles. The ultimate Malaysian comfort food.

Thankfully, I have my carton of Indomie Mee Goreng to make the nights go easier. But of late I've been craving something else.

Specifically curry noodles. Something spicy, that would heat you up so much that you could go shovel the snow off the driveway naked. I grew up eating Maggi noodles but admittedly, I've never been a huge fan of their chewy, doughy noodles.

And then, thanks to people like Suanie who enjoys torturing Malaysian expatriates abroad (heh), I read about what is supposedly the hit in Malaysia.

Chances are, if you live in Malaysia currently, you know what I'm talking about. It's supposed to be the tastiest, heartiest, spiciest, best curry noodle ever. Apparently they lace it with some drug or something. Even my brother living in Australia is crazy about it.

But, reading about this online and looking at the pictures, when you're having the late-night munchies on a cold night, is torture.

Unfortunately, I haven't been able to locate any for sale here. For the rest of us overseas losers, apparently we have to wait a few years before it hits US shores.

So, if anyone knows of a US retailer that sells this online, please let me know. Or if there are any kind souls wanting to deliver a few cartons to a starving Malaysian, that would be much appreciated

About Me

A Malaysian endocrinologist, trained in a major academic center in USA, and now surviving in the world of practice after 12 years of training.
To maintain patient confidentiality, names, ages and genders have been altered (And some stories totally fabricated to fool gullible readers).
This site is not meant to provide medical advice or consultation.